The present debate over the Indian patent law, despite the passion, is underscored by the desire to score political points. Consequently, most of the arguments have been disconnected from reality. India has been a proving ground for those who oppose patents on pharmaceutical products. We scrapped all product patents in 1972. As a result, India is now home to over 20,000 pharmaceutical companies producing copies of drugs developed óand patentedó elsewhere. However, access to medicines remains pooró suggesting that patents are not the key determinant of access that their opponents claim.

In India, medicine represents between 10 and 15% of total health care costs. This will not rise substantially when product patents are introduced, for two reasons. First, over 90% of the medicines in the Indian market are now off-patent globally. Second, for most of those that would be patentable, there are close alternatives available which provide effective competition. Poverty and associated malnutrition dramatically exacerbates the incidence of Malaria and TB, preventable diseases that continue to play havoc in India decades after they were eradicated in rich countries. Poor sanitation and polluted water sources prematurely end the life of about 1 million children under the age of five every year.

The real reason for the lack of access to medicines and other forms of healthcare is the prevailing stranglehold of government regulation of health sector. The public sector healthcare provision is a sick joke, characterised by shortages of hospitals, beds, equipments, medicines, and manpower. Claims of medical negligence and malpractice are frequent. Hospitals in India are often dangerous places. In spite of the risk of infection with HIV, the government of India recently admitted that 69% of injections administered in public hospitals could be unsafe.

In the face of poverty, inadequate health care delivery systems, and grossly inadequate sanitation systems, patents should at best be at the periphery of the health care debate, not at its centre. Yet many have argued that the introduction of product patents will undermine access by driving up prices of medicines. Several Health NGOs have claimed that AIDS patients will be particularly adversely affected by the introduction of product patents, saying that the price of medicine in India is likely to shoot up.

The New York Times added its weight in a recent editorial which argued that the poor in India and elsewhere will be denied access to AIDS medicine if India amends its patent laws to include product patent. Yet it is conveniently ignored the fact that barely 1% of the estimated 3.5 million Indians with AIDS receive any kind of treatment at all. Some international NGOs have added their voice, saying that poor countries in Africa that import cheap generic medicines from India may suffer. It is ironic that these activists think Indian generic producers could save lives in Africa, when the same companies fail to reach out to patients at home. Clearly, for many NGOs, ideological antipathy towards MNCs, patents and profitability in the health sector takes priority over issues that actually affect health care for the poor.

This debate over patent has done a disservice to the poor patients by shifting the focus away from the more serious illness that afflicts the health care system in India. Proper delivery of medicine is dependent upon a lot of factors- access to and availability of appropriate medical personnel, diagnostic facilities, treatment regimen, regular monitoring, diet and nutrition, etc. Without this basic infrastructure, health care can hardly be delivered effectively nor can medicine be administered properly. Patent or not. Priced or not.

Left wing political parties have also been vocal opponents of pharmaceutical product patents warning about the danger of the Indian health care sytem falling prey to profit seeking multinational corporations. Yet, they ignore the fact that most Indians dread the day they visit a public health facility. By contrast, some of the private healthcare sector in India is so well regarded that it is attracting ëëhealth tourists'' from overseas. The policies of the leftists would, ironically, perpetuate this two-tier system, instead of enabling every Indian to access high quality healthcare.

Political expediency is at the fore among other mainstream political parties. The present UPA government promulgated an ordinance to amendment that would make the Indian patent law compliant with WTO obligations in January 2005. The previous BJP-led NDA government had accepted the WTO obligations. Ironically, the then Commerce Minister who had originally introduced the amendment in Parliament, in December 2003, now says that he was misled about the implications of the bill, and has come out in opposition. The Indian pharma sector claims that its price competitiveness will be compromised by the new patent law. Yet, many of them complain that they need protection from Chinese generic and bulk drug manufacturers. It should not come as a surprise that some of the Indian companies showed more interest in producing generic lifestyle drugs like Viagra, rather than meet the basic health care needs of Indians.

With globalisation, several of the major India pharma companies, including Ranbaxy and Dr Reddy's, are seeking to break out of this mould and rub shoulders with the best in the world. This move is to be warmly welcomed- but will only happen once the companies are able to obtain patent protection for their product locally. Then, the pharma industry will attract investors from around the world. A deregulated and competitive health sector will stimulate research and innovation, and make quality service accessible to Indians. This will facilitate more private sector provision of hospitals, laboratories, manpower, insurance, and investment in R&D. Like in case of software, this will optimise the utilisation of Indian manpower in the pharma sector, and consequently the cost of drug development and research will fall.

Thursday, January 6, 2005

The world responded actively to the tragedy in South and South East Asia. Aid, financial and otherwise poured in from all parts of the world. Unfortunately, thousands of people perished as the response to the tragedy was not fast enough, and the blame should be placed squarely on the politics. My article titled "The Politics Of Relief" was published in TCS Daily on January 6th 2005.

The tragedy in South and South East Asia has shaken the world. Barely ten days after the tsunami swept thousands of kilometers of coastlines, killing an estimate 150,000 people and displacing millions, world leaders gathered for a mini summit in Indonesia to take stock and promise more money and technology. The UN is to lead the effort. The international community is estimated to have pledged over USD 2 billion in relief and rehab. The overwhelming grief of the victims is being matched by an enormous outpouring of sympathy and support. Money and material are pouring in from all across.

But the response has been too slow, and politics are to blame for that. No one will know how many thousand victims perished either at sea, or of thirst, or for lack of medical attention trapped beneath debris of buildings, because relief did not reach these people in time. Politics is the number one reason for this slow response to rescue and relief operations when it was most needed.

Indonesia, the country most seriously affected by the tsunami, had an insurgency in the Aceh province. Aceh was a closed province where journalists and aid workers need special permission to go. The Indonesian government first wanted relief material for Aceh to land hundreds of kilometers away and then be taken by road on a twelve hour journey to the affected areas. News media reported that when the first foreign doctors reached Aceh, some Indonesian military personnel asked what they were doing there. It took three days for the government in Jakarta to allow international relief to reach the most affected areas.

In India, the government announced its decision not to seek international aid. As an aspiring power she sent relief missions to other affected countries. India said that it was adequately endowed, with money and manpower to deal with this crisis by itself. An official explained that India wanted the international relief to go to areas where relief was more urgently needed, and where local capacity to deal with the crisis was limited.

Perhaps it was the ideology of self-reliance that had a part in the failure to raise an alarm at the onset of the tragedy, even if it was Indian lives that were at stake. Perhaps it was national security concerns, since Nicobar had an air force station, and India is said to be monitoring the region from there. Or the nuclear power plant near Chennai that had to be shut down because of the tidal surges: could military aircrafts from US or Australia be allowed to fly over such sensitive areas?

Perhaps there were more practical reasons. At the last major earthquake disaster in Gujarat province, India, in 2001, around 30,000 people lost their lives. There were many reports of international relief and rescue teams stranded at airports, because of logistical and information bottlenecks. By politely refusing foreign assistance this time, the authorities may have been seeking to avoid the same the embarrassment.

The international community too had other priorities. It is not politically correct to blame Mother Nature for heaping this misery. So the search for some other scapegoats was on, and today, the world has a universal punching bag --- the United States. For a couple days, there were headlines that some UN official had called the US `stingy` for failing to open its purse strings enough. Over the week, the US government raised its pledge ten-fold to about USD 350 million.

As for the UN, its record of handing disasters, natural or man-made, is less than impressive. If the oil-for-food scandal in Iraq is any indication, a new UN agency to deal with this disaster will not inspire confidence. Few may remember that the UN had declared the 1990s to be the Decade for Natural Disaster Reduction.

China has over the past week reportedly raised its contribution from USD 3 million to around USD 65 million. China's slow response may have dented her aspiration to be regional political force. On the other hand the Islamic countries of the Arabian Gulf region have received some criticism for exhibiting restraint while the most affected country, Indonesia, is the world's largest Muslim nation.

Europe proposed debt relief for many of the affected countries. Such relief has often helped recipient governments to perpetrate failed policies, and perpetuate poverty; the poor paid the price for those failed economic policies and continue to remain vulnerable to natural disasters.

At the summit in Indonesia, the leaders should seek people-oriented, market-driven diverse operations, much beyond the hands of bureaucrats and professional aid agencies. For instance, direct cash transfer to the victims, either a lump sum through a bank account, or a weekly dispersal, allowing them to decide how and where they would like to begin reconstruction of their lives would be a good start.

The present crisis provides an opportunity to seize the political initiative and push through fundamental reforms. Poor people deserve better.